Operative nuances of endoscopic third ventriculostomy for pediatric obstructive hydrocephalus

Background: Pediatric obstructive hydrocephalus is a relatively prevalent condition that may cause significant social and financial burdens. Current standard management is ventricular shunting with implantation of various ventriculoperitoneal (VP) shunt devices. This procedure is costly and has high complication rate. Endoscopic third ventriculostomy (ETV) is available as an option and considered to be superior to VP shunt. Methods: All of the pediatric obstructive hydrocephalus cases admitted to Sanglah General Hospital between 2005 until 2016 that were treated by ETV were described. Results: In 184 cases of ETV procedure in Sanglah General Hospital for pediatric obstructive hydrocephalus we have 92.6% of success rate. The complications are quite low, one patient (0.5%) died because of bleeding; two patients (1%) suffered wound infection, one person (0.05%) had meningitis and Cerebrospinal Fluid (CSF) leakage on three patients (1.6%). ETV cannot be done in eight patients (4.3%) due to the unidentifiable third ventricle. Conclusion: ETV is a simple yet effective procedure for pediatric obstructive hydrocephalus. Knowledge about intraventricular anatomic variations is very important in order to provide high success rate and low risk of complication.